Provider Demographics
NPI:1700608098
Name:CARROLL, CASSIE MCLAUGHLIN (RD, LDN)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MCLAUGHLIN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5741
Mailing Address - Country:US
Mailing Address - Phone:601-927-0355
Mailing Address - Fax:
Practice Address - Street 1:3800 I-55 N FRONTAGE RD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212
Practice Address - Country:US
Practice Address - Phone:601-200-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS812680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered